Menopause is a natural life stage, but the transition can be challenging — hot flushes, sleep problems, mood changes, brain fog, and other symptoms affect quality of life for millions of Australian women. This guide explains what to expect and how your GP can help, including modern hormone replacement therapy (HRT) and other treatment options.
Perimenopause vs Menopause
Perimenopause is the transition period leading up to menopause — typically starting in the mid-40s but sometimes earlier. Hormone levels fluctuate, periods become irregular, and symptoms can begin. Perimenopause can last 4–10 years.
Menopause is officially diagnosed when you have not had a period for 12 consecutive months. The average age of menopause in Australia is 51.
Postmenopause refers to the years after menopause. Many symptoms improve, but some (vaginal dryness, bone density loss, cardiovascular risk) need ongoing attention.
Common Symptoms
- Vasomotor: Hot flushes, night sweats
- Menstrual changes: Irregular, heavier, or lighter periods; missed periods
- Sleep problems: Insomnia, frequent waking
- Mood: Anxiety, low mood, irritability, brain fog
- Cognitive: Memory lapses, difficulty concentrating
- Genitourinary: Vaginal dryness, painful intercourse, recurrent UTIs, urinary urgency
- Musculoskeletal: Joint pain, muscle aches
- Skin and hair: Thinning skin, hair loss, new facial hair
- Libido: Reduced sex drive
- Weight: Weight gain, especially around the middle
When to See a GP
- Symptoms affecting your work, relationships, or quality of life
- Very heavy or prolonged periods in perimenopause
- Bleeding after menopause (bleeding 12+ months after your last period is NEVER normal and needs urgent assessment)
- Severe mood changes or suicidal thoughts
- Early menopause (before age 45) or premature ovarian insufficiency (before 40)
- Questions about HRT or non-hormonal treatments
- Family history of osteoporosis, heart disease, or breast cancer — these affect HRT decisions
Do I Need Blood Tests?
In most women over 45 with typical symptoms, menopause is diagnosed on history alone — no blood tests needed. Hormone levels (FSH, oestradiol) fluctuate so much in perimenopause that single tests are unreliable.
Blood tests may be useful if:
- You are under 45 with symptoms (to rule out early menopause)
- You are under 40 with symptoms (premature ovarian insufficiency)
- You have had a hysterectomy and cannot use periods as a marker
- You are using contraception that suppresses periods
Hormone Replacement Therapy (HRT)
HRT — now called Menopausal Hormone Therapy (MHT) — is the most effective treatment for hot flushes, night sweats, and vaginal dryness. Modern HRT is safer than the older products used in the early 2000s, and for most women starting within 10 years of menopause, the benefits outweigh the risks.
HRT options:
- Oestrogen-only: For women who have had a hysterectomy. Tablets, patches, gels, or sprays.
- Combined (oestrogen + progestogen): For women with a uterus. Progestogen protects the uterus lining.
- Tibolone (Livial): A synthetic alternative that acts like both oestrogen and progestogen.
- Local vaginal oestrogen: Cream, tablet, or ring inserted into the vagina. Used for genitourinary symptoms (dryness, UTIs) with minimal systemic absorption. Safe for almost all women.
Your GP will discuss the risks, benefits, and best product for your situation. HRT is not suitable for everyone — women with a history of breast cancer, blood clots, or certain other conditions may need alternative approaches.
Non-Hormonal Treatment Options
- SSRIs and SNRIs: Some antidepressants (venlafaxine, paroxetine, escitalopram) reduce hot flushes by 50–65%
- Gabapentin: Effective for hot flushes and night sweats
- Clonidine: Blood pressure medication with some anti-flush effect
- Cognitive behavioural therapy (CBT): Evidence-based for hot flushes, sleep, and mood
- Lifestyle: Regular exercise, weight management, reduced caffeine and alcohol, layered clothing, cool bedroom
- Mindfulness and yoga: Helpful for stress, sleep, and overall wellbeing
Bone Health After Menopause
Oestrogen protects bones, so bone density drops rapidly in the first few years after menopause. Women are at significantly increased risk of osteoporosis. Your GP may recommend:
- Calcium and vitamin D
- Weight-bearing and resistance exercise
- Bone density scan (DXA) — often bulk billed for eligible women
- Osteoporosis medication if bone density is low
Heart Health After Menopause
Cardiovascular risk rises after menopause. Regular GP checks of blood pressure, cholesterol, and blood sugar become even more important. See our high blood pressure guide.
Mental Health During the Transition
Anxiety, depression, and brain fog are common during perimenopause and often under-recognised. If your mood is affected, talk to your GP — a Mental Health Treatment Plan can provide access to psychology support.
Specialist Menopause Care
Family Doctor operates Ovara Women’s Health, a dedicated women’s health service with GPs specialising in menopause, HRT, PCOS, and women’s GP care. Many Family Doctor clinics also have female GPs with a special interest in menopause — ask when you book.
Find a Family Doctor Clinic Near You
Menopause symptoms are treatable. Book a long consultation with your GP to discuss your options — do not put up with symptoms that are affecting your life.
Frequently Asked Questions
Is HRT safe?
For most women starting within 10 years of menopause or under age 60, the benefits of HRT outweigh the risks. The risk profile depends on the type, dose, duration, and delivery method. Transdermal (patch, gel, spray) oestrogen has a lower risk profile than oral tablets. Your GP will personalise the discussion to your individual risk factors.
How long can I take HRT?
There is no fixed cut-off. Many women take HRT for 5–10 years or longer if symptoms persist. The decision is made together with your GP based on ongoing benefits, risks, and your preferences.
Can I take HRT if I had breast cancer?
Systemic HRT is generally not recommended after breast cancer, but local vaginal oestrogen may be an option in some cases. Non-hormonal approaches (SSRIs, CBT, gabapentin) are commonly used. Your GP will work with your oncologist.
Does HRT cause weight gain?
No — evidence does not support HRT causing weight gain. Weight changes around menopause are mainly due to ageing and lifestyle factors. HRT may actually help with some weight redistribution.